上海市社区卫生服务中心中药药事管理现状与发展对策

Current Situation and Development Countermeasures of TCM Pharmaceutical Administration of Community Health Service Centers in Shanghai

目的:了解上海市社区卫生服务中心中药药事的管理现状和存在问题,为提高基层医疗机构中药药事管理工作水平提供参考。方法:于2019年3-5月,对上海市243家社区卫生服务中心的中药药事管理现状进行问卷调查,包括被调研机构的基本情况、中药饮片管理、中药处方点评和中药自制制剂等情况。共发放问卷243份,回收有效问卷237份,有效回收率为97.5%。结果:233家社区卫生服务中心建立并落实了符合规范的中药房管理等各项中药药事管理制度;2017年该市社区卫生服务中心中药饮片的门诊处方平均为15814.7张、代煎处方平均为2898.9张,2018年该市社区卫生服务中心中药饮片的门诊处方平均为15256.5张、代煎处方平均为3552.1张。211家社区卫生服务中心建立并落实了中药饮片处方点评工作制度,220家能够定期开展中药处方点评工作。3家社区卫生服务中心有医院自制制剂品种。结论:上海市社区卫生服务中心的中药饮片服务覆盖率较高,已建立起较为完善规范的中药处方点评管理制度,但是仍存在中药代煎企业监管力度仍需加强、中药处方点评人员素质尚待提高、中药自制制剂研制和使用较为薄弱等问题。建议通过制订区域性规范文件、建立多方参与的质量监管体系、加强中药临床药师的培训、为中药自制制剂提供政策性支持等措施,提高该市基层医疗机构中药药事管理水平。

OBJECTIVE:To know about the management status and problems of TCM pharmaceutical administration in Community Health Service Centers(CHS)in Shanghai,and provide referrence for improving the level of TCM pharmaceutical administration in primary health institutions.METHODS:From March to May 2019,a questionnaire survey was conducted on the current situation of TCM pharmaceutical administration in 243 CHS of Shanghai,including the basic situation of the surveyed institutions,management of TCM decoction pieces,review of TCM prescription and situation of hospital-made TCM preparations,etc.A total of 243 questionnaires were issued,237 valid ones were recovered,with an effective recovery rate of 97.5%.RESULTS:233 CHS had established and implemented a standardized pharmaceutical administration.In 2017,the average number of outpatient prescriptions for TCM decoction pieces was 15814.7,while that of decocting prescription was 2898.9.In 2018,the average number of outpatient prescriptions for TCM decoction pieces was 15256.5,while that of decocting prescription was 3552.1.211 CHS had established and implemented the working system of TCM decoction pieces prescription review,and 220 CHS could carry out the work of TCM prescription review regularly.3 CHS had hospital-made TCM preparations.CONCLUSIONS:There is high coverage rate of TCM decoction pieces service in CHS in Shanghai,and a relatively perfect and standardized management system of TCM prescription review has been established.However,there are still some problems,such as the supervision of Chinese medicine decocting enterprises still needing to be strengthened,the quality of personnel for TCM prescription review needing to be improved,and the development and use of hosipital-made TCM preparations being relatively weak.It is suggested that the level of TCM pharmaceutical administration in primary medical institutions should be improved by formulating regional standard documents,establishing quality supervision system with multiple participation,strengthening the training of clinical pharmacists of TCM,and providing policy support for hosipital-made TCM preparations.